Jeffrey Segal, M.D.: Defensive medicine spiking health care costs

Tuesday

May 1, 2012 at 1:37 PM

Blood work, biopsies, MRIs, CT scans, stress tests, EKGs and sonograms. Eighty two percent of doctors order more tests and procedures than are medically necessary, and almost on a daily basis, in fear of potential lawsuits.

According to a recent poll conducted by the Gallup organization, about one in four dollars spent in health care can be attributed to these tests and procedures that are clinically unnecessary. The problem has become so overwhelming that earlier this month a group of nine medical specialty boards launched the Choosing Wisely initiative, asking doctors to cut back on 45 tests and procedures that provide little value to patients.

The medical profession is to be commended for drawing attention to exuberant testing. But while the profession is starting to raise awareness about defensive medicine, it might not change the behavior of doctors until we change our medical tort system. As some doctors have told me they have no choice but to “scan some patients until they glow” as long as they can be hauled into court for frivolous reasons.

Doctors order up tests, in most cases,. not because it was necessary to diagnose what was wrong but because if they didn’t and something went very wrong, they believe they would not have been protected in a lawsuit. Patients for Fair Compensation, a non-profit seeking to educate policymakers about defensive medicine, estimates that unnecessary tests and procedures cost about $650 billion a year. That is money spent on the unnecessary MRI the doctor ordered for a worker with a nagging backache, for example, and the EKG the physician ordered on an otherwise healthy 36-year-old patient with no history of heart disease.

The $650 billion in lost revenue spent on unnecessary tests includes money coming out of the pockets of taxpayers. Up to $125 million a year is paid by Medicare for unnecessary tests and procedures and up to $96 billion is paid by Medicaid for unneeded tests and procedures.

Here’s a brief list of what many patients can do without:CT scan after an uncomplicated fainting episode.Stress test with a routine physical absent cardiac symptoms or a family history of heart disease.Chest x-rays for patients undergoing routine outpatient surgery when accompanied by a normal physical exam.Antibiotics for routine sinusitis.Osteoporosis screening for women under age 65.

Doctors often feel compelled to order these tests or treatments because patients demand it. In today’s world, patients expect quick remedies for their symptoms. When they don’t get immediate relief, they push physicians to use the latest technologies to discover what’s wrong. It’s the American way. As long as a doctor feels he could be the potential target of a frivolous lawsuit, he will keep ordering the tests and procedures. The only substantive solution is to revamp our nation’s medical tort system so physicians don’t feel the need to double-check their diagnosis with expensive testing.

States such as Florida and Georgia are considering a model to move to an administrative, non-adversarial system called the Patients’ Compensation System. There, patients could take their claim to a panel similar to a workers’ compensation board. Patients would then know their case would be heard within months instead of years. And they would receive quick, predictable settlements.

The system would keep doctors from being hauled into court as they would not be held personally liable for any tort claims, either legitimate or frivolous. Doctors would still pay professional liability premiums, as before. And there would still be a way to address doctors who should not be practicing. It’s important to note that the majority of doctors who have been sued are not bad doctors. They are either a doctor who should never have been sued. Or a good doctor who made a mistake.

A Patients’ Compensation System would make it easier to dramatically reduce the number of unnecessary tests and procedures and bring down health care costs for individuals and companies who pay premiums, co-pays and the escalating cost to obtain health insurance.

The specialty boards and the Choosing Wisely campaign is a great first step to raise awareness about defensive medicine. But doctors will never change their behavior about ordering too many tests until we change our broken legal system and ensure that both patient and doctor are protected.

Segal, a neurosurgeon, is CEO of Medical Justice and a board member of Patients for Fair Compensation, a non-profit seeking to revamp the medical tort system in states throughout the country.

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